Experts Delve into Issue of Wound Infections after Blast Injuries

By Crystal Maynard, USAMRMC Public Affairs

Michael Leggieri, director of the Department of Defense Blast Injury Research Program Coordinating Office,
kicked off the 2016 International State-of-the-Science meeting in Arlington, Nov. 29.
(Photo by Crystal Maynard, USAMRMC Public Affairs)

The Department of Defense Blast Injury Research Program Coordinating Office hosted the 2016 International State-of-the-Science Meeting Minimizing the Impact of Wound Infections Following Blast-Related Injuries in Arlington, Virginia, Nov. 29 - Dec. 1.

Setting the tone for the meeting, Dr. John Holcomb, a retired Army colonel and director of the Center for Translational Injury Research at the University of Texas Medical School in Houston, presented the keynote address and shared the story of how a Soldier was injured in 2006 during a blast while riding in a Humvee. The Soldier lost both legs below the knee and has suffered chronic infections over the past decade since the blast.

"I am passionate about this subject, and I know that the rest of the panel is as well. I couldn't be more supportive of this effort," said Holcomb. "Think about how much suffering and morbidity could have been avoided in that one Soldier if his infections that followed the initial injury were successfully treated. Now multiply that one Soldier by the thousands in just this war. How would have receiving better diagnoses and better diagnostics changed the life of this Soldier? Rapid and accurate diagnosis is key."

The International State-of-the-Science Meeting series was established in 2009 to assist the DOD Executive Agent for Blast Injury Research in identifying knowledge gaps pertaining to key blast injury research issues.

"The International State-of-the-Science meeting series supports the executive agent's responsibilities to identify knowledge gaps that inform the medical research community and program managers of research that they can build into their portfolios to close those gaps," said Michael Leggieri, director of the DOD Blast Injury Research Program Coordinating Office and meeting planning committee chair, as he kicked off the meeting. "Our goal is to identify what we know and what we don't know about wound infections following a blast-related injury, and then to try to develop some recommendations that can advance the science and deliver needed solutions to Service Members."

The widespread use of explosive weapons reinforces the need for research on blast injuries for both military and civilian victims of conflict and terrorism. Victims of explosions often suffer from multiple traumatic injuries; the mechanism, severity and complexity of these injuries contribute to the risk for wound infection. At the same time, multi-drug resistance is growing worldwide, with very few new or next generation anti-infective drugs in development. As a result, effective prevention, mitigation and treatment strategies for wound infections remain a critical need for both the U.S. military and civilian populations.

Approximately 120 subject matter experts from the DOD, other federal agencies, academia, industry and international organizations participated in the meeting.

"Each year, we [the DOD Blast Injury Research Program] assemble a very diverse meeting planning committee comprising stakeholders from across the DOD and outside the DOD that goes through a very intensive process on determining what is the topic of greatest importance to the DOD that needs to be addressed, and this year wound infection rose to the very top of the topic list," said Leggieri. "It takes diverse disciplines to solve these very complex blast injury problems. It's not possible to solve these problems within a single community, so we try to include as many disciplines as possible in these meetings."

This is the sixth year that the International State-of-the-Science Meeting has been held and the first year that wound infection has been the focus. Approximately one quarter of combat wounds become infected, which has a significant impact on patient outcomes and healthcare costs.

Leggieri challenged the audience, "Think not just about future research, but what can be done now or in the very near future in terms of changes in policy or other practices that could make a difference and move us forward."

Following the keynote address, a series of topic and scientific sessions were held to examine specific issues relating to wound infections following a blast-related injury. Each session involved a question and answer session from the subject matter experts probing further into the research presented.

After the presentations, participants broke into working groups that addressed four specific questions formulated by the meeting planning committee:

How can our understanding of risk factors of wound infections, bacterial or fungal, following blast-related injuries be applied in advance prediction, prevention, detection and treatment strategies?

What candidate biomarkers, from either host or pathogen, can potentially enable rapid and accurate diagnosis, management and prognosis of wound infections and biofilm formation following blast-related injuries?

What prevention strategies, to include the use of vaccines, can be employed to reduce the incidence of wound infections across the continuum of care (point of injury to U.S. military hospital setting) following blast-related injuries and what are the challenges in fielding these?

What strategies hold the most promise for the treatment of wound infections associated with blast-related injuries and what are the challenges in fielding these?

"If you bring diverse disciplines together and ask each group to answer the same questions, you get perspectives on each of those questions that you wouldn't have gotten otherwise," said Leggieri. "It is our goal to take these answers and to drive change in policy, care and treatment for Service Members that develop infection following a blast-related injury."

The findings from the meeting are synthesized into a report that will be publicly available on the DOD Blast Injury Research Program website, and it will also be formally staffed up to the executive agent and seen by DOD leadership.

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